FIG. 5.

The progressive state of β-cell dysfunction in type 1 diabetes—a model for stages of depression? As noted in the text, increasing data support a model of progressive β-cell dysfunction in type 1 diabetes. Meaning, from the activities of a variety of “stressors,” (e.g., inflammation, glucolipotoxicity, ER stress, etc.), β-cells move from a state of normalcy to a “stressed” state by a process that depletes the insulin storage pool. Therefore, β-cells proceed to a state where dysfunctional insulin secretion occurs, along with expansion and distortion of the ER. The end stage is one of “assisted suicide,” where the immunologic parameters, when combined with unique susceptibilities inherent to β-cells, lead to their ultimate demise.